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American Journal of Transplantation 12, 1 (2012) 202-9
High incidence of anticytomegalovirus drug resistance among D+R- kidney transplant recipients receiving preemptive therapy.
L. Couzi, S. Helou, T. Bachelet, K. Moreau, S. Martin 1, D. Morel, M. E. Lafon, B. Boyer 2, S. Alain 3, I. Garrigue 4, P. Merville
(01/2012)

Anti-cytomegalovirus (CMV) prophylaxis is recommended in D+R- kidney transplant recipients (KTR), but is associated with a theoretical increased risk of developing anti-CMV drug resistance. This hypothesis was retested in this study by comparing 32 D+R- KTR who received 3 months prophylaxis (valganciclovir) with 80 D+R- KTR who received preemptive treatment. The incidence of CMV infections was higher in the preemptive group than in the prophylactic group (60% vs. 34%, respectively; p = 0.02). Treatment failure (i.e. a positive DNAemia 8 weeks after the initiation of anti-CMV treatment) was more frequent in the preemptive group (31% vs. 3% in the prophylactic group; p = 0.001). Similarly, anti-CMV drug resistance (UL97 or UL54 mutations) was also more frequent in the preemptive group (16% vs. 3% in the prophylactic group; p = 0.05). Antiviral treatment failures were associated with anti-CMV drug resistance (p = 0.0001). Patients with a CMV load over 5.25 log(10) copies/mL displayed the highest risk of developing anti-CMV drug resistance (OR = 16.91, p = 0.0008). Finally, the 1-year estimated glomerular filtration rate was reduced in patients with anti-CMV drug resistance (p = 0.02). In summary, preemptive therapy in D+R- KTR with high CMV loads and antiviral treatment failure was associated with a high incidence of anti-CMV drug resistance.
1 :  Laboratoire de Biophotonique et Pharmacologie - UMR 7213 (LBP)
CNRS : UMR7213
2 :  Institut de Physique Nucléaire d'Orsay (IPNO)
CNRS : UMR8608 – IN2P3 – Université Paris XI - Paris Sud
3 :  Teaching hospital
Teaching hospital
4 :  Microbiologie cellulaire et moléculaire et pathogénicité (MCMP)
CNRS : UMR5234 – Université Victor Segalen - Bordeaux II
Sciences du Vivant/Microbiologie et Parasitologie

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